Hwang Franchesca, Crandall Marie, Smith Alan, Parry Neil, Liepert Amy E
Department of Surgery, New York University Grossman School of Medicine, New York, CA, USA.
Department of Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL, USA.
Surg Endosc. 2023 Jan;37(1):638-644. doi: 10.1007/s00464-022-09428-y. Epub 2022 Aug 2.
Small bowel obstruction (SBO) is a common disease affecting all segments of the population, including the frail elderly. Recent retrospective data suggest that earlier operative intervention may decrease morbidity. However, management decisions are influenced by surgical outcomes. Our goal was to determine the current surgical management of SBO in older patients with particular attention to frailty and the timing of surgery.
A retrospective review of patients over the age of 65 with a diagnosis of bowel obstruction (ICD-10 K56*) using the 2016 National Inpatient Sample (NIS). Demographics included age, race, insurance status, medical comorbidities, and median household income by zip code. Elixhauser comorbidities were used to derive a previously published frailty score using the NIS dataset. Outcomes included time to operation, mortality, discharge disposition, and hospital length of stay. Associations between demographics, frailty, timing of surgery, and outcomes were determined.
264,670 patients were included. Nine percent of the cohort was frail; overall mortality was 5.7%. Frail had 1.82 increased odds of mortality (95% CI 1.64-2.03). Hospital LOS was 1.6 times as long for frail patients; a quarter of the frail were discharged home. Frail patients waited longer for surgery (3.58 days vs 2.44 days; p < 0.001). Patients transferred from another facility had increased mortality (aOR 1.58; 95% CI 1.36-1.83). There was an increasing mortality associated with a delay in surgery.
Patients with frailty and SBO have higher mortality, more frequent discharge to dependent living, longer hospital length of stay, and longer wait to operative intervention. Mortality is also associated with male gender, black race, transfer status from another facility, self-pay status, and low household income. Every day in delay in surgical intervention for those who underwent operations led to higher mortality. If meeting operative indications, older patients with bowel obstruction have a higher chance of survival if they undergo surgery earlier.
小肠梗阻（SBO）是一种常见疾病，影响包括体弱老年人在内的所有人群。近期的回顾性数据表明，早期手术干预可能会降低发病率。然而，管理决策受手术结果影响。我们的目标是确定老年患者小肠梗阻的当前手术管理方式，特别关注虚弱状况和手术时机。
使用2016年全国住院患者样本（NIS）对65岁以上诊断为肠梗阻（ICD - 10 K56*）的患者进行回顾性研究。人口统计学数据包括年龄、种族、保险状况、合并症以及按邮政编码划分的家庭收入中位数。使用NIS数据集，通过埃利克斯豪泽合并症得出先前发表的虚弱评分。结果包括手术时间、死亡率、出院处置方式和住院时间。确定人口统计学、虚弱状况、手术时机和结果之间的关联。
共纳入264,670例患者。队列中9%为虚弱患者；总体死亡率为5.7%。虚弱患者的死亡几率增加1.82倍（95%置信区间1.64 - 2.03）。虚弱患者的住院时间长1.6倍；四分之一的虚弱患者出院回家。虚弱患者等待手术的时间更长（3.58天对2.44天；p < 0.001）。从其他机构转来的患者死亡率增加（校正比值比1.58；95%置信区间1.36 - 1.83）。手术延迟与死亡率增加相关。
虚弱和小肠梗阻患者死亡率更高，更频繁出院至依赖性生活机构，住院时间更长，等待手术干预的时间更长。死亡率还与男性、黑人种族、从其他机构转来的状态、自费状态和低家庭收入相关。对于接受手术的患者，手术干预延迟每一天都会导致更高的死亡率。如果符合手术指征，老年肠梗阻患者尽早手术存活几率更高。
